A 72-year-old woman with systolic heart failure (LVEF 30%) initiated on lisinopril and carvedilol presents after 1 month with dyspnea and fatigue. Vital signs: BP 98/62 mmHg, HR 58 bpm, RR 18/min, SpO2 98% on room air. Serum creatinine increased from 1.2 to 1.5 mg/dL; potassium 5.2 mEq/L. Physical examination reveals no new peripheral edema. Which intervention is most appropriate?
- A)Switch lisinopril to a dihydropyridine calcium channel blocker
- B)Discontinue lisinopril immediately to prevent acute kidney injury
- C)Decrease carvedilol dose to reduce renal hypoperfusion
- D)Continue both medications; a small rise in creatinine is expected and typically stabilizesGABARITO
- E)Start aggressive diuretic therapy to improve renal perfusion
Explicação
A small, modest increase in serum creatinine (10-30%) within the first 1-2 months of ACE inhibitor and beta-blocker initiation in heart failure is expected and usually stabilizes. This represents the hemodynamic effect of reduced intraglomerular pressure and d... Ver explicação completa e trilha adaptativa →